A Complete Overview of Ambulatory Surgery Center Billing Guidelines

Ambulatory Surgery Center Billing Guidelines

Ambulatory Surgery Center Billing

Ambulatory surgery centers (ASCs) are specialized medical facilities that provide same-day surgical services and other procedures for individuals who don’t require hospitalization. ASCs offer a cost-effective, convenient alternative to traditional inpatient care, with the added benefit of quicker recovery times due to the outpatient nature of the procedure.  

However, billing for these services can be complicated and time-consuming if you aren’t familiar with ambulatory surgery center billing. This article will discuss what ambulatory surgery centers are, how they are billed, and common billing errors made in these types of facilities. 

 

What are Ambulatory Surgery Centers (ASCs)? 

An ASC is a specialized facility that provides same-day surgical services, including endoscopies, arthroscopic surgeries and other procedures that do not require hospitalization. These centers are typically owned by physicians or operated as freestanding businesses.  

They serve as an alternative to traditional inpatient care, offering a more cost-effective and convenient solution for patients who don’t require hospitalization. 

How Are ASCs Billed for Services Rendered? 

The billing process for ambulatory surgery centers is complex. Each insurance company has its ambulatory surgery center billing guidelines regarding how to bill for services rendered.  

When billing for ASC center services, coding staff should ensure that all necessary documents are reviewed and signed before claims submission. In addition, they should verify the correct CPT, HCPCS and ICD-10 codes for the services rendered. 

Some healthcare plans require providers to use a range of codes for different services provided. For example, when billing for anesthesia services, the provider must bill for both the professional and facility components to receive full reimbursement. 

Once all coding is complete, claims must be submitted via an electronic clearinghouse or directly to the payer. Providers can expect payment within 30 days of submitting claims. It is important to follow up on any unpaid or delayed claims in a timely manner. 

Finally, staff should review all payments received for accuracy and address any discrepancies with the payer promptly. It is also beneficial to keep track of all claim denials for future reference.   

ASC Documentation and Coding 

Providers need to follow the proper Ambulatory surgery center billing guidelines related to documentation and coding for proper reimbursement. 

ASC Documentation Guideline: 

Providers must document the medical necessity of a procedure and the details of both pre-operative and post-operative care. It's important to obtain accurate information from the patient, including any comorbidities that may affect their treatment or recovery, as well as detailed records regarding any medications they are currently taking. 

ASC Coding Guidelines:  

Providers should understand that ASC billing requires the combination of both ICD-10 and HCPCS level Codes. It depends upon the insurance carrier whether they allow healthcare providers to allow ICD-10 procedure codes or to follow HCPCS Codes.   

Providers should also understand the need to code accurately and completely, as any mistakes may lead to higher denials or lost reimbursements. It's important for providers to stay up-to-date with coding guideline changes, especially regarding reimbursement from insurance carriers.  

Common Billing Errors in ASCs and How to Avoid Them 

Some of the common billing errors that healthcare providers face are: 

Misuse of modifiers 

Misuse of modifiers is one of the most common billing errors made by health care providers in ambulatory surgical centers (ASCs). Modifiers provide additional information about a procedure and must be appropriately used according to the payer's requirements. However, if modifiers are misused, it can result in incorrect payments or even a denial of the claim. 

Incomplete documentation 

Incomplete documentation is another common billing error in ASCs. Documentation must include all necessary information about the services provided to accurately assess the health care service and determine if reimbursement is warranted. If a procedure or diagnosis code is not supported by sufficient documentation, it can result in a denial of the claim. 

Coding errors 

Coding errors are also another common billing error in ASCs. Each payer has its own coding requirements for submission and it’s important to understand these guidelines before submitting a claim. If a code is incorrectly assigned, it can lead to an incorrect payment or even a denial of the claim. 

Fortunately, there are some steps that can be taken to avoid these types of billing errors. These include: 

• Ensuring that all documentation is complete and accurate 

• Checking for correct coding and modifier usage 

• Staying up-to-date on any changes to payer requirements or guidelines 

• Working with a third-party billing and coding expert 

By taking these steps, healthcare providers can ensure that they submit accurate claims and avoid common billing errors in ASCs. This will help reduce the time spent dealing with rejected or denied claims and increase reimbursement rates. 

Final Words  

With proper adherence to the ambulatory surgery center billing guidelines, healthcare providers can ensure that their claims are accurate and timely, resulting in fewer denials and higher reimbursement rates.  

Working with a third-party billing and coding expert is key for success in ASCs, allowing you to benefit from their experience and knowledge of the ever-changing payer. HMS USA LLC, the best affordable billing company, can assist you with providing top-notch ASC billing services. So, Ping us now!